Laparoscopy is a surgical procedure performed through small incisions in the abdomen whereby a trocar/cannula device is inserted to provide a means for passage of medical instruments. A thin cylindrical instrument called a laparoscope, connected to a camera, is then used to provide a clear picture of the abdominal cavity to the surgeon.
Prior to starting a surgical procedure, a small incision is performed on the abdominal wall of the patient whereby a trocar/cannula device is inserted. Trocar device diameters range in size from 5 to 12 mm and provide a clear passage for the introduction of medical devices into the abdomen. A device called an insufflator is then used to inflate the abdominal cavity area with a gas such as carbon dioxide, creating space. Once the abdominal opening is secured, a special medical viewing device called a laparoscope is inserted thru the trocar opening permitting the surgeon to view the abdominal cavity space. Typically, several additional incisions are made ranging in size from 5-12 mm for the introduction of other medical devices.
The origins of the word Laparoscope can be traced back to the Greek word for “Laparo” meaning “flank”. A flank is the side of the body between the ribs and hips commonly referred to as the abdomen and the word “scope” meaning to look at or examine. Hence Laparoscopes provide a means of looking inside the abdomen of a person.
The first use of a Laparoscope goes as far back as 400 BC where the physician Hippocrates (460-377 BC) mentioned the use of a device called a rectoscope. Its use was for inspecting the oral cavity and pharynx of a person. When a tool is used to view the interior of a person thru a natural opening of the body such as the mouth or nose it is more accurately referred to as an endoscope. Laparoscopes and Endoscopes have permitted tremendous strides in the medical field.
It wasn't until 1805 that a physician named Phillip Bozzini of Mainz, Germany invented the Lichtleiter, also referred to as the Bozzini Endoscope. The Lichtleiter consisted of two parts, (1) a light container with an optical part and (2) a mechanical part which consisted of viewing channels adapted to fit inside a body. The Lichtleiter was a channel constructed of various attachments that used concave lenses whereby half of the channel transmitted the light from a candle to the tip of the device and the other half of the opening returned the reflected light showing the surgeon the interior view of the patient. The candle with angled mirrors inside the device provided the light that enabled the physician to see the abdominal cavity. This approach was not practical because of its limitations of maintaining a heated light source, but it was the predecessor of today's laparoscopes and at the time the first device to inspect the interior of a human body.
Laparoscopy continued to evolve. In 1901 a Doctor by the name of George Kelling performed the first examination of an abdominal cavity (in a dog) by inflating the cavity with gas and then inserting an endoscope. He is often credited with introducing the field of Laparoscopy. In 1910 Victor Elner used a gastroscope to view the interior of a stomach and shortly thereafter a flexible gastroscopy was designed. Thereafter, in 1911. the first Laparoscopy was performed on a human by the Swedish Doctor H. C. Jacobeus. In spite of the technical advances that were being made, problems persisted with the heat produced at the tip of the scope when a flame was used for lighting and visualization problems such as blind spots in the field of view. These problems limited the use of Laparoscopy. Its main purpose remained diagnostic.
In the early 20th century with the invention of the light bulb and electrical devices by Thomas Edison, significant advances began taking place. Small light sources could now be attached to the distal tip of Laparoscopes without the need for cooling. The next great evolution happened in the 1950's when significant advances took place in the field of fiber optics. Fiber Optics provided great flexibility and the introduction of even smaller light sources into the abdomen without burning the patient.
As surgeries kept evolving, limited interest was focused on minimally invasive type surgeries. It was believed that larger incisions were better. However as some of the many advantages of minimal invasive surgery became apparent such as lower operating cost, less patient trauma, less scarring, less pain, lower surgical complications, quicker recovery times, shortened hospital stays, and less chance of infection, a need developed to find therapeutic uses for Laparoscopy. In the 1970s, thanks to Gynecologists and Gastroenterologists, the use of Laparoscopy began changing from diagnostic to therapeutic uses.
The development of very small high-resolution television cameras and CCD (charged coupled devices) tremendously propelled advances in therapeutic uses. As problems presented themselves inventors focused on solutions that kept Laparoscopic surgeries moving forward. An example of how a problem in laparoscopy led to a great solution is the problem of fogging and visualization that developed in surgery. Inventors such as Ricardo Alexander Gomez, Sandy Lawrence Heck, and Eric Conley developed and patented a revolutionary method for maintaining laparoscopic lenses crystal clear during procedures and dramatically improved the visualization and effectiveness for these types of surgeries with the use of a device called a D-Help®.
As the field of minimally invasive surgery continues evolving less invasive techniques are desired. The need for smaller laparoscopic tools has also developed. A newer version of laparoscopy has evolved called needlescopic surgery. Needlescopic surgery is a progression of laparoscopic surgery whereby incisions smaller than 3 millimeters are made. Virtually no scarring occurs, pain is reduced, and recovery times are faster. However, the problem associated with this new type of procedure is the limited functionality of the insertion instrument. As the instruments became thinner, the heads of the instruments became smaller and less effective to manipulate tissues and organs. For this reason, among others, needlescopic surgery is not functional for most procedures and has not been widely adopted by the surgical community.
Another new type of surgery called Single Incision Laparoscopic Surgery (SILS) has also been tried to reduce the number of incisions related to surgery. The concept is that a single incision is made at the umbilicus allowing a specialized tool to be placed at the opening. The opening allows the insertion of several very small instrument tools into the abdomen. The problems associated with this procedure are first in the level of complexity for each procedure versus the traditional laparoscopic procedure, the lack of functionality of the smaller tools, and the very tight working area. It is usually limited to only 3 very small instrument devices which often lack the full functionality required by traditional surgeons.
Another new type of surgery used today is called (NOTES) Natural Orifice Transluminal Endoscopic Surgery. It basically involves placing a flexible endoscope through one of the body's natural orifices, like the mouth, anus, vagina, or urethra. Its purpose is to achieve access to a space near the affected area. Some of the problems associated with this type of surgery are that the number of instrument heads used is usually limited to only one, not all areas of the body are accessible, and since most views are two dimensional there are special orientation problems.
An additional problem associated with both Single Incision Laparoscopic Surgery (SILS) and Natural Orifice Transluminal Endoscopic Surgery (NOTES) are their lack of ability to achieve triangulation. Triangulation in this instance can be defined as the ability to come at a target from different directions or angles. Triangulation provides significant benefits to the surgeon, among them are: effective control of the surgical procedure and the ability to better manipulate internal body parts. When this ability is lost, it is difficult to effectively perform these types of surgeries. This is one of the reasons that have prevented SILS and NOTES from being widely adapted. Our Technology solves this problem by facilitating triangulation from many directions, a feature that is both lost in SILS and NOTES.
People have experimented with the concept of attaching larger instrument heads to thin shafts inside the body, but no effective method has been developed or invented to facilitate the insertion and attachment of such instrument heads within the body especially under direct visualization.
In laparoscopic surgery, incisions are made ranging from 5-12 mm and usually requiring up to 4 separate incisions. In the specialized field of needlescopic surgery the instrument heads are often too small and lack functionality. Visualization of the attachment process is also a problem that has limited the internal attachment process to an external one. The challenge has been in finding a means of inserting, removing and remotely attaching a normal sized medical instrument head inside the abdomen of a patient. The benefits are numerous to the patient including reduced scarring, quicker recovery times, less chance of infections, and lower morbidity risks associated with infections. The advantages to the surgeon are better handling, and better functionality of the instrument heads, often a tradeoff that is associated with smaller instrument heads.
As newer technologies continue to evolve, there is a need in the field for smaller tools having better rigidity and strength characteristics. In U.S. Patent Application Ser. No. 62/093,789, filed on Dec. 18, 2014, entitled “Method and Apparatus for Securing Laparoscopic Instrument Heads in the Abdomen Under Direct Visualization”, by same Inventors, a new technology is introduced whereby thin shafts having diameters measuring between 1-4 mm are introduced.
As elongated instruments continue to reduce in diameter, their rigidity comes into question. The further they are extended the weaker they become. Additionally, as thinner tools are used the means of attaching them securely to instrument heads are also needed.
These and other aspects, features and advantages of the present invention will become more readily apparent from the attached drawings and the detailed description of the preferred embodiments which follow.